CONSOLIDATION OF FEMORAL FRACTURES AT APPLICATION OF DIFFERENT TREATMENT METHODS TAKING INTO CONSIDERATION DURATION OF THE PERIOD FROM TRAUMA TO OSTEOSYNTHESIS

Abstract

Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis. Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used. The duration of post-operative observation of the animals was 100 days. Results. It has been found out that the dynamics of osteoreparative processes in the studied groups was similar and did not depend on the time between trauma and osteosynthesis. The median time for the femoral shaft fracture healing in animals of group 1 was 46 days (Q1-Q3: 38-57), in group 2 - 73 days (Q1-Q3: 71-78) (differences between groups are significant at p=0.004); in group 3 - 49 days (Q1-Q3: 44-60), in group 4 - 72 days (Q1-Q3: 70-93) (differences between groups are significant at p=0.008). It is shown that the reason for the increase in fixation terms in dogs with the delayed osteosynthesis is the long-term persistence of the acute phase reaction caused by trauma (using the growth of C-reactive protein as an example). Conclusion. The healing terms of a femoral shaft fracture with the use of PREF technology and BIOS technology are comparable, both in the conditions of urgent and delayed osteosynthesis. What this paper adds It has been determined the similarity of the osteoreparation dynamics in the healing of diaphyseal femoral fractures: under conditions of osteosynthesis with a pin-rod external fixation device (PREF) and blocked intramedullary osteosynthesis (BIOS). For the first time it has been shown that healing terms of a diaphyseal femoral fractures when osteosynthesis performed in 4 days after injury is 1.5 fold longer in comparison with the performance of osteosynthesis within 1 hour after the injury. For the first time it has been shown that in the case of delayed osteosynthesis, the effectiveness of PREF and BIOS is comparable in terms of the duration of the consolidation of the diaphyseal femoral fractures.